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Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

Page 7 of 75

121.

A nurse is educating a patient with type 2 diabetes about a lifestyle change needed for health improvement, but the patient is resistant to making the change. What is the MOST effective approach?

  • Explore the patient’s reasons for resistance

  • Explain the potential negative consequences of failing to make the lifestyle change

  • Respect the patient’s autonomy and accept their decision

  • Explore alternative lifestyle changes that could accomplish the same effect

Correct answer: Explore the patient’s reasons for resistance

Exploring the patient’s reasons for resistance helps the nurse understand the patient's perspective and address their concerns. This approach can lead to finding mutually acceptable solutions that the patient is more likely to follow.

Explaining the potential negative consequences of failing to make the lifestyle change may feel coercive and can increase the patient's resistance.

Simply respecting the patient’s autonomy and accepting their decision does not address the underlying reasons for their resistance or help them improve their health.

Exploring alternative lifestyle changes that could accomplish the same effect might be helpful, but it is more effective to first understand the patient’s specific reasons for resistance.

122.

A patient with a fractured fibula is receiving skeletal traction and has external fixation in place. Which of the following do you instruct the nursing assistant to report immediately?

  • The traction weights are resting on the floor

  • The patient is complaining of pain and muscle spasm

  • The patient wants to change position in bed

  • There is a small amount of clear fluid on the skeletal pin sites

Correct answer: The traction weights are resting on the floor

Skeletal traction involves pulling force (weight may reach 10-40 pounds) applied directly to the bone, allowing traction to be tolerated for longer periods of time. 

When the traction weights are resting on the floor, they are not exerting pulling force to provide reduction and alignment, or to prevent muscle spasm. The weights should always hang freely. Attending to the weights may reduce the patient’s pain and spasm. 

With skeletal pins, a small amount of clear fluid drainage is expected. It is important to inspect the traction system after a patient changes position because position changes may alter the traction.

123.

A patient with a terminal illness decides to refuse further treatment even though they understand the implications. Which action best demonstrates the nurse's role in advocating for the patient?

  • Respect and support the patient's decision

  • Attempt to convince the patient to continue treatment to prolong their life

  • Inform the patient's family about the decision and its implications

  • Encourage the patient to seek a second opinion from another healthcare provider

Correct answer: Respect and support the patient's decision

Respecting and supporting the patient's decision is crucial as it upholds the principle of autonomy and ensures the patient's wishes and rights are honored. Advocacy in nursing involves ensuring the patient's preferences are respected and supported, especially in sensitive situations involving end-of-life care.

Attempting to convince the patient to continue treatment disregards their autonomy and fails to respect their informed decision. Informing the patient's family about the decision without the patient's consent breaches confidentiality and may not align with the patient's wishes. Encouraging a second opinion can undermine the patient's autonomy and suggest their informed decision is not being respected.

124.

Which of the following is most likely to a pre-renal cause of kidney failure?

  • Endocarditis

  • Systemic lupus erythematosus

  • Glomerulonephritis

  • Renal calculi

Correct answer: Endocarditis

Pre-renal causes of kidney failure are causes of decreased perfusion that occur due to factors that occur before blood reaches the kidneys. Endocarditis can lead to decreased circulation due to decreased cardiac output and is a potential cause of pre-renal kidney failure. Intra-renal causes of kidney failure are due to the kidneys themselves and include glomerulonephritis or diseases affecting the kidneys directly, such as systemic lupus erythematosus. Post-renal causes of kidney failure are causes that occur distal to the kidneys in the urinary tract, and can be caused by renal calculi.

125.

You are caring for Mr. J, a patient receiving parenteral nutrition via a tunneled catheter (Broviac). Which of the following statements regarding this patient's care and treatment do you know to be true?

  • If this patient is willing to do so and his condition allows, he will be able to administer his nutrition at home

  • Broviac catheters may be inserted at the patient's bedside

  • Dislodgement of the Broviac catheter is most likely to occur 3-4 weeks after placement

  • Broviac catheters are most commonly placed in the basilic vein and advanced into the superior vena cava

Correct answer: If this patient is willing to do so and his condition allows, he will be able to administer his nutrition at home

Tunneled catheters (Hickman, Broviac, and Groshong) are indicated when there is a need for central venous access for more than 4 weeks (longer-term) and are therefore a good choice for home nutrition options.

They must be inserted in the operating room (peripherally inserted central catheters [PICCs] are inserted at the patient's bedside), and for this reason are expensive. The catheter is most commonly placed in the subclavian vein into the superior vena cava (PICCs are inserted peripherally into a large vein in the arm such as the basilic vein). Catheter dislodgement most likely will occur in the first 2 weeks after insertion (until fibrin growth anchors it in place).

126.

You are caring for Mr. H., who was admitted for an exacerbation of ulcerative colitis (UC). You gather the following data during your admission assessment:

  • Objective: Temperature: 101 degrees F, pulse 108, blood pressure: 101/55, respiratory rate: 20, O2 saturation: 98% room air
  • Subjective: frequent bloody stools, decreased appetite with a 6-pound unexpected weight loss. noncompliance with pharmaceutical treatment plan due to financial restraints.

All of the following consultations should be made for the patient except:

  • Pain management

  • Gastroenterologist

  • Nutritionist

  • Social Work

Correct answer: Pain management

Consultations that should be made include nutritionist for educating patient on dietary modifications to manage symptoms, social work to discuss community resources for financial and psychosocial support, and gastroenterologist for close monitoring and follow-up of patient's UC (if surgical procedure is indicated, this would be performed by gastroenterologist). 

Pain management is not generally necessary as symptoms can be well managed with drug therapies consisting of aminosalicylates, antimicrobials, corticosteroids, immunosuppressants, and biologic therapy.

127.

A patient is diagnosed with scoliosis with a spinal curve of 45 degrees. What is the recommended treatment?

  • Surgery to correct spinal curvature

  • Close monitoring every 6 months for disease progression

  • Postural exercises

  • Back bracing in the patient

Correct answer: Surgery to correct spinal curvature

Surgery is generally recommended for curves greater than 40 degrees. Surgical options include anterior or posterior spinal fusion, or combined anterior and posterior surgery as a staged procedure.

Curves of less than 20 degrees require close observation for progression every six months with postural exercises that may be prescribed. Curves of 20-40 degrees require bracing in a growing child, and surgery in the adult (bracing is ineffective in skeletally mature patients).

128.

A nurse is caring for a patient who has a Do Not Resuscitate (DNR) order. The patient goes into cardiac arrest, telling the nurse “Save me!” right before he passes out. How should the nurse respond?

  • Begin administering CPR

  • Follow the DNR order

  • Contact the hospital’s ethics committee for direction

  • Take every action possible to save the patient aside from providing CPR

Correct answer: Begin administering CPR

When the patient verbally requests "save me," this statement effectively rescinds the DNR order, as it indicates the patient's change in wishes regarding resuscitation. Nurses are ethically and legally required to honor the patient's most current and expressed wishes, which would now call for life-saving measures.

Following the original DNR order is incorrect because the patient’s explicit verbal request supersedes the prior written directive. Contacting the hospital's ethics committee is not necessary in this situation because the nurse must act immediately based on the patient's current request. Taking every action possible aside from CPR is also inappropriate, as it does not fully address the patient’s immediate desire for resuscitation.

129.

An obese, type 2 diabetic patient who is non-insulin dependent is best controlled by weight loss for which of the following reasons?

  • Because obesity reduces insulin binding at receptor sites

  • Because obesity reduces the number of insulin receptors

  • Because obesity reduces pancreatic islet cell exhaustion

  • Because obesity reduces pancreatic insulin production

Correct answer: Because obesity reduces insulin binding at receptor sites

Obesity reduces insulin binding at the receptor sites (insulin resistance), which leads to pancreatic hypersecretion of insulin and eventual pancreatic cell exhaustion.

Diet, exercise, and weight loss are extremely important to improve insulin sensitivity and resistance.

130.

The emergency nurse is performing a sexual assault assessment on a rape victim. In terms of evidence collection, what does "trace" mean?

  • Small or minute

  • Fleeting

  • Transient

  • Invisible

Correct answer: Small or minute 

Trace evidence is evidence that is transferred from one person to another person or place and is normally caused by objects or substances coming in contact with one another (no matter how slight the contact), resulting in a small or minute sample left on the contact surface(s). Of the four classifications of evidence (trace, physical, transient, and patterned), trace and physical evidence are the most likely pieces of evidence to establish the facts of a crime. 

Emergency nurses are regularly in contact with essential evidence in criminal cases and often unknowingly either discard or damage vital evidence; thus, it is important for emergency nurses to understand principles of evidence (and how to preserve it) when evaluating patients who have been involved in a crime.

131.

You are caring for a patient who was just diagnosed with Hodgkin’s lymphoma who asks you "What are my chances of surviving this cancer?" Which of the following responses is best?

  • "Hodgkin's lymphoma is one of the most treatable cancers an adult can have."

  • "Hodgkin's lymphoma is not something that can kill you; you will just be sick for a few months."

  • "There is no cure for Hodgkin's lymphoma, and it is almost always a terminal disease."

  • "Your odds of surviving would be better if you had non-Hodgkin's lymphoma."

Correct answer: "Hodgkin's lymphoma is one of the most treatable cancers an adult can have."

Hodgkin's lymphoma is considered to be among the most treatable of adult cancers. 

While Hodgkin's lymphoma may have a better prognosis than most types of cancer, it can still be fatal. Hodgkin's lymphoma is often not a terminal disease if treated correctly. Hodgkin's lymphoma is associated with better survival rates that non-Hodgkin's lymphoma.

132.

A nurse is teaching a patient with low health literacy about managing their diabetes. What is the MOST effective teaching strategy?

  • Use simple language and visual aids to explain concepts

  • Give the patient extensive written materials to support their knowledge

  • Only discuss the most basic elements of managing diabetes and avoid complex information

  • Provide teaching to the patient's family member who has higher health literacy

Correct answer: Use simple language and visual aids to explain concepts

Using simple language and visual aids helps make complex information more understandable for patients with low health literacy. This approach ensures the patient can better grasp the essential aspects of managing their diabetes and improve their self-care.

Extensive written materials can be overwhelming and difficult for patients with low health literacy to comprehend, reducing the effectiveness of the teaching. Only discussing the most basic elements may leave out important information the patient needs to effectively manage their diabetes.

While involving a family member can be helpful, the primary focus should be on ensuring the patient understands how to manage their condition.

133.

A patient with severe left upper quadrant pain has been diagnosed with chronic pancreatitis. The patient asks the nurse, "Will I ever feel better?" Which response by the nurse is best?

  • "Your symptoms will subside; however, the disease will progressively get worse."

  • "Unfortunately, the pain will get slowly and progressively worse."

  • "With treatment, the pain will eventually go away and should not come back; however, there may be some lasting damage to your pancreas."

  • "Are you contemplating suicide?"

Correct answer: "Your exacerbation will subside, however, the disease will progressively get worse."

Chronic pancreatitis is a progressive disease characterized by periods of exacerbation and remission. It is correct to tell the patient that their symptoms will subside, but they should know that the disease will progressively worsen. While the pain may worsen during other exacerbations, there will be periods of remission. The patient's question does not indicate that they are contemplating suicide, and an evaluation of whether the patient is suicidal is not warranted at this point.

134.

A female patient has just been diagnosed with human papillomavirus (HPV). What information is appropriate to tell this patient?

  • This condition puts her at higher risk for cervical cancer; she should have a Pap smear every 6 months

  • The potential for transmission to her sexual partner(s) will be eliminated if condoms are used every time she engages in sexual intercourse

  • The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days

  • HPV causes lesions called condylomata acuminata that cannot be transmitted during oral sex

Correct answer: This condition puts her at higher risk for cervical cancer; she should have a Pap smear every 6 months

HPV is the most common viral sexually transmitted infection (STI); (although chlamydia is the most frequently reported STI). Women with condylomata acuminata (HPV) are at risk for cancer of the cervix and vulva. Yearly Pap smears are crucial for early detection; if diagnosed, Paps are necessary every 6 months to monitor for cervical changes. 

Because condylomata acuminata is a virus, there is no permanent cure. Other treatments include topical cytotoxic medications, cryotherapy, electrocautery, or surgery. 

Because it can occur on the vulva, a condom won’t protect sexual partners. HPV can be transmitted to her parts of the body, such as the mouth, oropharynx, and larynx; HPV can be transmitted during oral sex.

135.

A nurse learns a patient is using traditional healing methods at home instead of the prescribed medication even though they understand the purpose of the prescribed treatment. What is the nurse's best response?

  • Respect the patient's choice and collaborate on an integrative care plan

  • Explain to the patient why the prescribed medication is necessary

  • Explain the consequences of non-compliance to the patient

  • Inform the patient of science that shows why their traditional methods are ineffective

Correct answer: Respect the patient's choice and collaborate on an integrative care plan

Respecting the patient’s choice and collaborating on an integrative care plan is the appropriate action, as it honors the patient's autonomy and cultural beliefs while finding a way to effectively incorporate both traditional and prescribed treatments. This approach builds trust and encourages adherence to a mutually agreed-upon treatment plan.

Simply explaining why the prescribed medication is necessary might not address the patient's preference for traditional methods and can seem dismissive.

Focusing on the consequences of non-compliance relies on fear rather than understanding and cooperation, potentially disrespecting the patient's cultural beliefs.

Dismissing the traditional methods as ineffective could damage the therapeutic relationship and overlook the importance of cultural competence in healthcare.

136.

When deep palpation is used to assess a patient's abdomen, which of the following would the nurse not expect to be able to palpate?

  • The spleen

  • The right kidney

  • The liver

  • The colon

Correct answer: The spleen

The spleen may be palpable when using deep palpitation; however, this would be an abnormal finding. Parts of the right kidney, the liver, and the colon may be expected to be palpable during deep palpation. Deep palpation should only be performed by midlevel providers or phsycians.

137.

Which of the following is MOST important for a patient with type 1 diabetes who has confusion, tremors, nausea, and palpitations?

  • Measure the patient's blood glucose level

  • Apply oxygen and check a set of vital signs

  • Administer an amp of 50% dextrose

  • Perform an EKG

Correct answer: Measure the patient's blood glucose level

A patient with type 1 diabetes who has confusion, tremors, nausea, and palpitations is likely to be hypoglycemic. This should be verified by measuring the patient's blood glucose level. If the patient is hypoglycemic, the hypoglycemia should be treated by having the patient ingest rapid-acting sugars or by injecting an amp of 50% dextrose if the patient is unable to take oral intake. The blood glucose level should, however, be measured first. Performing an EKG may be appropriate if the patient's symptoms are not caused by hypoglycemia. While applying oxygen and checking a set of vital signs could be appropriate, checking blood glucose levels is more important.

138.

A nurse is planning care for a patient who has been placed in restraints. Which of the following actions is MOST important to include in the care plan?

  • Remove restraints every 2 hours to check skin integrity

  • Ensure the restraints are checked every 24 hours

  • Restrict the patient's fluid intake to minimize the need for bathroom breaks

  • Administer sedatives to keep the patient calm

Correct answer: Remove restraints every 2 hours to check skin integrity

Removing restraints every 2 hours to check skin integrity is crucial to prevent pressure injuries, ensure proper circulation, and assess the patient's physical and emotional condition. This practice helps mitigate the risks associated with prolonged use of restraints.

Ensuring the restraints are checked every 24 hours is insufficient as it does not address the frequent monitoring needed to prevent complications such as skin breakdown and circulatory impairment. Restricting the patient's fluid intake to minimize the need for bathroom breaks is inappropriate and can lead to dehydration and other complications. Adequate hydration is essential for patient health. Administering sedatives to keep the patient calm is not a standard or ethical practice for managing patients in restraints and can lead to unnecessary sedation and adverse effects.

139.

When evaluating a patient for symptoms associated with acute pancreatitis, the nurse would observe for:

  • Turner's sign

  • Increased intracranial pressure (ICP)

  • Bradycardia

  • Hypertension

Correct answer: Turner's sign

Turner's sign is bruising of the lower abdomen and flank areas, indicative of a retroperitoneal bleed associated with acute pancreatitis.

ICP is not affected in a patient with pancreatitis. Tachycardia (not bradycardia) is usually associated with hypovolemic or pulmonary complications of pancreatitis. Hypotension (not hypertension) is associated with shock as seen in acute pancreatitis.

140.

A nurse on a medical-surgical unit must delegate a task to a nursing assistant. Which task is MOST appropriate for this delegation?

  • Taking the vital signs of an unstable patient

  • Assessing a patient with pain at their surgical site

  • Teaching a patient about their discharge medications

  • Evaluating a patient’s response to a new treatment

Correct answer: Taking the vital signs of an unstable patient

Taking the vital signs of any patient is an appropriate task to delegate to a nursing assistant because it involves gathering objective data. This task does not require clinical judgment or decision-making, making it suitable for the nursing assistant to perform and report back to the nurse for further action.

Assessing a patient with pain at their surgical site, teaching a patient about their discharge medications, and evaluating a patient’s response to a new treatment are tasks that all require clinical judgment and specialized knowledge. These responsibilities involve assessing underlying causes, patient education, and decision-making, which are beyond the scope of a nursing assistant’s training and abilities, making them inappropriate to delegate.

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